Transcription:

Melanie Cole (Host):  Many people have felt that discomfort of heart burn but what exactly is acid reflux disease and how can somebody find relief? My guest today is Dr. Juan Jose’ Blondet. He is a bariatric and general surgeon with Allina Health United General Surgery Clinic. Welcome to the show, Dr. Blondet. Tell us a little bit about GERD, acid reflux disease, and what people are really suffering from when they have this.

Dr. Blondet (Guest):  Thanks, Melanie for having me.  GERD or gastro esophageal reflux disease is actually a very common complaint from a lot of patients. Basically, it is the lower esophageal sphincter, the valve that separates the esophagus from the stomach, becomes worn out and allows some reflux of acid from the stomach up into the esophagus creating this very uncomfortable heart burn or discomfort that a lot of people feel. This is, unfortunately, very, very common. The problem is not only the symptoms of the patient are very uncomfortable – heartburn or pain that they have – but it is also the esophagus which is very sensitive to acid, the inner lining of the esophagus, starts getting very damaged. That can actually have a lot of very serious complications.

Melanie:  Does it affect some people more than others?

Dr. Blondet:  Actually, acid reflux can affect anyone at any age. I see patients in my practice young adult, healthy, male, female, older patients. It can actually affect anyone. It is definitely more common in middle age and older patients but I see a very broad variety of patients complaining with very difficult GERD problems.   Overall, statistically all of the studies have shown 1 in 5 adult American suffer from symptoms of GERD.

Melanie:  Sometimes GERD can be a little bit silent. You don’t always feel those symptoms. What are some of the complications if you do not know that you have it or if you have it and you just take Tums every once in a while and pay no attention to it?

Dr. Blondet:  That is very true, actually. The most common symptoms of GERD are heartburn, maybe some upper abdominal discomfort or pain. It can actually be chest discomfort as well. I see a lot of patients going to the emergency department thinking they are having a heart attack. Of course, the emergency doctors are ruling out the most dangerous problem, which is the heart attack, and then finding out that they actually, indeed, have GERD.  Some patients can have regurgitation of food and in more rare symptoms patients can actually have worsening of their asthma and chronic cough, sore throat. But, as you mentioned, it’s true, some patients can actually have what is called “silent GERD” even with heartburn the acid from the stomach can wash up all the way up to the airwaves causing what I was describing – sore throat, hoarseness, chronic cough. Some people actually feel they have this trouble swallowing or this nagging feeling of something being stuck in the back of their throat. They see several doctors. They cannot figure out what’s going on. Those can be what we call silent GERD.

Melanie:  Dr. Blondet, we need the acid in our stomach to help break down the bacteria in our food and with digestion. People take all of these antacids so that they don’t suffer from heartburn and they’re on proton-pump inhibitors and all of these things. Don’t we need that acid? What should we do so that we can work on the GERD without getting rid of that stomach acid that we need?  

Dr. Blondet:  That is absolutely true. We do need the acid. Acid is needed and that’s actually why we have it in the stomach. It’s needed to break down foods, break down medications, to absorb different types of nutrients including iron which is extremely important. We do need the acid. The problem is that we take all of these anti-acid medications to basically patch a problem. We are not fixing a problem by just decreasing the amount of acid. The question we have to answer is why would a patient have high acid amounts?  Or, why would a patient have reflux when the normal amount of acid is produced in the stomach? That’s where I come. As a surgeon, I deal with those patients. I do several different procedures to prevent continuous reflux. We need to keep that acid in the stomach. We just don’t need it in the esophagus.

Melanie:  So then, what do you recommend as your first line of defense? What do you do with patients when they come to you and they say they’ve got heart burn?

Dr. Blondet:   The first thing we have to do is see if there’s any lifestyle modifications we can actually do. If you are smoking, you have to stop smoking. That is the overall number one problem.  Not only for your overall health--everybody knows about lung cancer and about all these other digestive cancers that we can have from smoking—but smoking significantly increases the change of heart burn. Also, complications after somebody has heartburn or reflux or ulcers. The second thing is, we have to change some of the diet habits that we have. Some people are very keen on very spicy foods. Some people immediately can recognize when they eat chocolate or they eat any kind of mint, they will have heart burn. That is the first thing that we have to do. Try to stop those things to relieve the pain or until the discomfort gets better. The number two really effective and very reasonable way to battle GERD is starting you on an acid reducer medication, just one time a day, and see if you respond. Most patients will respond with a once a day medication. When the patient starts getting worse with once a day medication or several years pass and you are still taking that acid reducing medication, you are actually becoming dependent to it. You cannot just stop it otherwise you have some really bad problems. That’s when you have to talk to your doctor and see if there is any other alternative. That’s where, again, I come into play. A surgeon can help you stop all of these problems with the heartburn, reflux and regurgitation.

Melanie:   Do you think that people should have endoscopies, Dr. Blondet, to see what our state is with GERD and reflux, just as we have colonoscopies for prevention?

Dr. Blondet:   Maybe not for prevention. Several studies have not shown a significant improvement on regular what we call “screening” upper endoscopies as with colon cancer which is very well described and very well approved for prevention of colon cancer. GERD is different. If somebody has GERD, I definitely recommend getting an upper endoscopy to see how the overall lining of the esophagus is or if there already is damage that we can actually focus on. If a patient has a normal endoscopy and they have the symptoms, just continuing with medication should be okay. If somebody develops worsening GERD or we’re adding different types of symptoms now like weight loss or problems eating, feeling food getting stuck in the lower part of the esophagus, then a repeat endoscopy for sure is indicated.

Melanie:   In just the last few minutes, Dr. Blondet, give your best advice for people listening about lifestyle things they can do to help their GERD including even some natural and home remedies people try like apple cider vinegar, milk or yogurt. They try all of these things. Kind of wrap it up for us and give us your best advice about gastroesophageal reflux disease.

Dr. Blondet:   Sure. Milk and yogurt, for example, were some of the things we used to do in the ‘70s and ‘80s to try to mitigate the symptoms of GERD. We have proven that it actually makes it worse. That is one of the myths that we have to completely eradicate from GERD. Milk and yogurt have very high protein concentration. That actually increases the acid in the stomach. Some patients come to see me when they are already making changes. They are already trying to sleep with their head elevated. Putting wedges in their beds. Some of them feel that they have improved. I don’t recommend doing that because if you are already having those problems, you need to get that problem fixed. Obesity for sure increases the amount of reflux. Watching your weight, definitely eating healthy, small meals, low portions, low calories will make you lose weight and decrease the pressure in the abdomen, helping you with the GERD. I see a lot of patients in my practice when they have already passed all these stages; when they have already made all of these lifestyle modifications and they need help. We have several minimally invasive surgeries that we do with very high success rates. The most common one is what’s called a Nissen fundoplication which has been done for several years all over the world and is extremely effective to prevent further reflux. We have a new kid on the block, the last few years which is actually called a LINX procedure and is even more minimally invasive, less dissection, implanting a ring of magnets in the lower part of the esophagus to prevent reflux. These magnets will open and close depending on any bolus of food when you’re eating will open and will stay closed preventing any further reflux. The results we are getting from these procedures is extremely well – almost 96% of patients will be completely off PPIs or other acid reducing medication and go back to having a normal life.

Melanie:  So cool. That’s absolutely fascinating. Thanks so much for being with us, Dr. Blondet. You’re listening to The WELLcast with Allina Health. For more information, you can go to AllinaHealth.org. That’s AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.